BACKGROUND: Patients treated with regional anesthesia often require concomitant medication for comfort and sedation. Propofol is widely used for this purpose, but studies upon awareness or post-operative retrograde amnesia are limited. So we designed this study to investigate the frequency of retrograde amnesia on various effect-site concentrations of propofol by using target controlled infusion (TCI). METHODS: Ninety patients (ASA I, II) undergoing orthopedic or urogenital surgery with spinal, epidural or axillary block were randomly assigned to one of six groups. Target concentrations of propofol in the six groups were respectively 1.0, 1.2, 1.4, 1.6, 1.8, or 2.0 microgram/ml. When the effect site concentration reached the target concentration in each group, we waited for 5 minutes and then lowered the target concentration to 0.5 microgram/ml. When the effect site concentration returned to 0.5 microgram/ml, we again waited for 5 minutes and then showed the patient number and picture cards and asked the patient to memorize them. Subsequently the target concentration was returned to the original level. In the post anesthesia care unit, retrograde amnesia was checked 2 hours after eye opening and then rechecked 24 hours later. RESULTS: The percentages of retrograde amnesia checked 2 hours after eye opening were 27%, 27%, 40%, 40%, 40%, and 53% (number card) and 27%, 27%, 40%, 47%, 53%, and 63% (picture card) for propofol dose of 1.0, 1.2, 1.4, 1.6, 1.8, and 2.0 microgram/ml. A significant correlation was found between the propofol concentration and the percentage of retrograde amnesia for picture but not for the numbered cards. The percentages of retrograde amnesia observed at 24 hours after eye opening were similar to the 2 hour results. CONCLUSIONS: When propofol is used for sedation at 1.0 2.0 microgram/ml, retrograde amnesia increases in proportion to the effect site concentration. Many patients can recall intra-operative awareness, and thus we cannot be assured of effective retrograde amnesia. Therefore although a patient is under deep sedation, careful consideration of awareness and recall is needed.
Amnesia, Retrograde* ; Anesthesia ; Anesthesia, Conduction ; Deep Sedation ; Humans ; Orthopedics ; Propofol*

BACKGROUND: Oropharyngeal manipulation is problematic when patients have a gag reflex. Sedation can suppress gag reflex, but can cause serious airway problems. We compared remifentanil (Group R) and propofol (Group P) in terms of cooperation and loss of gag reflex, while drugs were administered incrementally using target controlled infusion (TCI). METHODS: Fifty seven patients who required awake fiberoptic intubation were randomized to Group R or Group P. After measurement of baseline gag trigger point index (GTPI), TCI was set to effect-site concentration (Ce) of 1 ng/ml (Group R) or 1 microg/ml (Group P), then titrated by 0.5 increment until GTPI score reached 0. The incidence of drop-out and decreased cooperation, Ramsay sedation scale (RSS) and Ce at loss of GR, and complications were assessed. RESULTS: Seven patients were dropped out in Group P due to deep sedation and disobedient behavior, but none in Group R (P = 0.015). Gag reflex suppressed as RSS increased in both groups (P < 0.001), however, the incidence of elimination of gag reflex clustered at RSS 2 in Group R (P < 0.001), whereas it was evenly distributed in Group P (P = 0.20). The incidence of patients who were spontaneously roused (gag reflex elimination at RSS 1 and 2) were higher in Group R than in Group P (P = 0.002). CONCLUSIONS: Deep sedation and impaired cooperation were observed only in Group P and spontaneously roused patients were higher in Group R, suggesting that remifentanil is more suitable for cooperative elimination of GR.
Conscious Sedation ; Deep Sedation ; Humans ; Incidence ; Intubation ; Piperidines ; Propofol ; Reflex ; Trigger Points

The frequency of procedures in the emergency department has increased with changes in the medical environment and the demands of the times. Especially in children, sedation and analgesia are often inevitable due to the difficulty in seeking cooperation. Procedural sedation and analgesia is essential for successful completion of procedure, but the medical personnel who perform it must be prepared for complications caused by medications. Safe procedural sedation and analgesia requires well-trained medical personnel and well-prepared equipment, including appropriate patient assessments and choice of medications, faithful monitoring, and resuscitation. This review focuses on understanding of sedation processes, patient evaluation, medications, and monitoring.
Analgesia ; Anesthesia ; Child ; Conscious Sedation ; Deep Sedation ; Emergencies ; Emergency Service, Hospital ; Humans ; Resuscitation

BACKGROUND: In a noisy hospital setting, it is not easy to induce hypnosis or sedation calmly. Although the noise stress has been neglected, it seems to disturb a patient's sleep or induction of sedation. Therefore, we tried to evaluate the effects of loud operating room (OR) background noise on bispectral index (BIS) during monitored anesthesia care (MAC) by using an audiometer and BIS monitor. METHODS: Thirty adult patients (ASA class I) were scheduled two times for nasal or dental procedures at an interval of two or three days. In a randomized, cross-over study design, we prospectively compared the BIS values according to the loudness of OR noise in two different depths of sedation during MAC. Propofol target controlled infusion (TCI) was started at a propofol target concentration (CT) 2.0 microgram/ml using a DiprifusorTM with flash mode until a BIS 80 and/or a modified Observer's Assessment of Alertness/Sedation (mOAAS) score of 4 (group 1), and BIS 75 and/or mOAAS score 3 (group 2) was obtained. We evaluated the effect site concentrations and the elapsed time and checked the BIS at 50, 80, 110, and 120 dB of sound pressure level (SPL) in both groups. RESULTS: The BIS at 80, 110 and 120 dB of SPL in group 1 was significantly increased compared to those at 50 dB (P < 0.05). Similarly, the BIS at 110 and 120 dB of SPL in group 1 was significantly increased compared to those at 80 dB (P < 0.05). The patients in their twenties were most susceptible to loud OR noise during sedation. CONCLUSIONS: The loud OR background noise might be possible to interfere with induction of sedation to a degree, which was more noticeable on light to moderate sedation than for deep sedation.
Adult ; Anesthesia* ; Conscious Sedation ; Cross-Over Studies ; Deep Sedation ; Humans ; Hypnosis ; Noise* ; Operating Rooms* ; Propofol ; Prospective Studies

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable procedure that requires adequate sedation for its successful conduction. We investigated the efficacy and safety of the combined use of intravenous midazolam and propofol for sedation during ERCP. METHODS: A retrospective review of patient records from a single tertiary care hospital was performed. Ninety-four patients undergoing ERCP received one of the two medication regimens, which was administered by a nurse under the supervision of a gastroenterologist. Patients in the midazolam (M) group (n=44) received only intravenous midazolam, which was titrated to achieve deep sedation. Patients in the midazolam pulse propofol (MP) group (n=50) initially received an intravenous combination of midazolam and propofol, and then propofol was titrated to achieve deep sedation. RESULTS: The time to the initial sedation was shorter in the MP group than in the M group (1.13 minutes vs. 1.84 minutes, respectively; p<0.001). The recovery time was faster in the MP group than in the M group (p=0.031). There were no significant differences between the two groups with respect to frequency of adverse events, pain experienced by the patient, patient discomfort, degree of amnesia, and gag reflex. Patient cooperation, rated by the endoscopist as excellent, was greater in the MP group than in the M group (p=0.046). CONCLUSIONS: The combined use of intravenous midazolam and propofol for sedation during ERCP is more effective than midazolam alone. There is no difference in the safety of the procedure.
Amnesia ; Cholangiopancreatography, Endoscopic Retrograde* ; Conscious Sedation ; Deep Sedation ; Humans ; Midazolam* ; Organization and Administration ; Patient Compliance ; Propofol* ; Reflex ; Retrospective Studies ; Tertiary Healthcare

In South Korea, as in many other countries, propofol sedation is performed by practitioners across a broad range of specialties in our country. However, this has led to significant variation in propofol sedation practices, as shown in a series of reports by the Korean Society of Anesthesiologists (KSA). This has led the KSA to develop a set of evidence-based practical guidelines for propofol sedation by non-anesthesiologists. Here, we provide a set of recommendations for propofol sedation, with the aim of ensuring patient safety in a variety of clinical settings. The subjects of the guidelines are patients aged ≥ 18 years who were receiving diagnostic or therapeutic procedures under propofol sedation in a variety of hospital classes. The committee developed the guidelines via a de novo method, using key questions created across 10 sub-themes for data collection as well as evidence from the literature. In addition, meta-analyses were performed for three key questions. Recommendations were made based on the available evidence, and graded according to the modified Grading of Recommendations Assessment, Development and Evaluation system. Draft guidelines were scrutinized and discussed by advisory panels, and agreement was achieved via the Delphi consensus process. The guidelines contain 33 recommendations that have been endorsed by the KSA Executive Committee. These guidelines are not a legal standard of care and are not absolute requirements; rather they are recommendations that may be adopted, modified, or rejected according to clinical considerations.
Advisory Committees* ; Conscious Sedation ; Consensus ; Data Collection ; Deep Sedation ; Humans ; Korea ; Methods ; Patient Safety ; Propofol* ; Standard of Care

Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation. The deployment of non-anesthesia administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall health care costs without sacrificing sedation quality. This review will discuss efficacy, safety, efficiency, cost and satisfaction issues with various modes of sedation for non-advanced, non-emergent endoscopic procedures, mainly esophagogastroduodenoscopy and colonoscopy.
Analgesics, Opioid ; Anesthesia ; Benzodiazepines ; Colonoscopy ; Conscious Sedation ; Deep Sedation ; Endoscopy ; Endoscopy, Digestive System ; Health Care Costs ; Propofol

Anesthetic care is usually provided for patients undergoing surgical procedures to make them unconscious and painless during surgery. Nowadays there are increasing therapeutic or diagnostic procedures performed outside operating room. Sedation is more frequently provided as healthcare during procedures for patient's comfort and safety by non-anesthesiologist or anesthesiologist. Early in 1999, ASA (the American Society of Anesthesiologists defined sedation and analgesia and established 4 states: minimal sedation, moderate sedation, deep sedation, and general anesthesia. Monitored anesthetic care implies the potential for a deep sedation and is always administered by an anesthesiologist. It is not always possible to predict how an individual patient will respond by nature of being a continuum of sedation. Hence, practitioners intending to induce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. The standards for preoperative evaluation, intraoperative monitoring, anesthetic care, etc. are not different from those for general anesthesia.
Analgesia ; Anesthesia* ; Anesthesia, General ; Conscious Sedation ; Deep Sedation ; Delivery of Health Care ; Humans ; Methods ; Monitoring, Intraoperative ; Operating Rooms

Anxiety and phobia in dental procedures are common deterrents for patients visiting the dental care unit. For these individuals, procedural sedation may aid in completion of dental treatments. In most cases, the patients are conscious during sedation, thereby allowing spontaneous ventilation. Intravenous sedation (IVS) is widely used during dental treatment to relieve patient anxiety. IVS is the most effective route of administration to achieve this goal, but it requires advanced training, more than that provided during undergraduate education. During IVS, rapid onset, repetitive drug administration, easy titration, and rapid recovery from sedation can be achieved. However, conscious sedation during IVS can result in deep sedation that can cause respiratory and cardiovascular depression. Therefore, the characteristics of intravenous sedatives should be known. The purpose of this review is to discuss the characteristics and usage of intravenous sedatives currently used for dental procedures.
Anesthetics, Intravenous ; Anxiety ; Conscious Sedation ; Deep Sedation ; Dental Care ; Dentistry ; Depression ; Education ; Humans ; Hypnotics and Sedatives ; Phobic Disorders ; Ventilation

Anxiety and phobia in dental procedures are common deterrents for patients visiting the dental care unit. For these individuals, procedural sedation may aid in completion of dental treatments. In most cases, the patients are conscious during sedation, thereby allowing spontaneous ventilation. Intravenous sedation (IVS) is widely used during dental treatment to relieve patient anxiety. IVS is the most effective route of administration to achieve this goal, but it requires advanced training, more than that provided during undergraduate education. During IVS, rapid onset, repetitive drug administration, easy titration, and rapid recovery from sedation can be achieved. However, conscious sedation during IVS can result in deep sedation that can cause respiratory and cardiovascular depression. Therefore, the characteristics of intravenous sedatives should be known. The purpose of this review is to discuss the characteristics and usage of intravenous sedatives currently used for dental procedures.
Anesthetics, Intravenous ; Anxiety ; Conscious Sedation ; Deep Sedation ; Dental Care ; Dentistry ; Depression ; Education ; Humans ; Hypnotics and Sedatives ; Phobic Disorders ; Ventilation